Western Mindanao State University

College of Nursing
Zamboanga City

Alternative Learning System

Related Learning Experience
Psychiatric - Mental Health 117B
Psychiatric Ward

Name of Student Opina, Vivienne Marie Louise G.

Section BSN 3D

Instructions:

1. Answer the provided questions comprehensively following the subsequent format.

a. Use the Arial Font Style.
b. Utilize at least three (3) or more references.
c. References should be 2016 and the latest.
d. The output should be submitted as posted in our Official MS Team.
e. Use the templates on pages 4–8 as guides in accomplishing your output.
2. You will be graded according to the Rubric on pages 9-10.

Case Scenario: Bipolar Disorder

Gary is a 19-year-old who withdrew from college after experiencing a manic episode during which he was
brought to the attention of the Campus Police (“I took the responsibility to pull multiple fire alarms in my dorm to ensure
that they worked, given the life-or-death nature of fires”). He had changed his major from engineering to philosophy and
increasingly had reduced his sleep, spending long hours engaging his friends in conversations about the nature of reality.
He had been convinced about the importance of his ideas, stating frequently that he was more learned and advanced than
all his professors. He told others that he was on the verge of revolutionizing his new field, and he grew increasingly
irritable and intolerant of any who disagreed with him. He also increased the number of high-risk behaviors – drinking
and engaging in sexual relations in a way that was unlike his previous history. Gary’s other symptoms include:
 Alcohol Use
 Depression
 Elevated Mood
 Impulsivity
 Irritability
 Mania/Hypomania
 Mood Cycles
 Risky Behaviors

Because of his behavior, Gary’s parents brought him to the hospital for consultation. During the visit, the
physician referred his case to the psychiatrist resident, and the latter ordered the following laboratory workups and
diagnostics:

What are the Write the implications for each

Complete Blood Count
Red Blood Cells
Patient’s Results normal values for test by correlating the normal
each test? and abnormal values
5.2 cells/mcL 4.5 to 6.2 Within normal range, no signs
cells/mcL of anemia or bleeding

Page 1 of 8
 White Blood Cells 9500 per mcL 3,400 to 9,600 Within normal range of RBCs,
cells/mcL no signs of infection or bone
marrow problem
Neutrophils 2.0 neutrophils/mcL 1.5-8.0 Within normal, no signs of the
neutrophils/mcL body fighting an infection
Eosinophils 2% 1%-4%
Monocytes 6% 2%-8% Within normal, no signs of
inflammation
MCV 90 femtoliters per cell 80-100 fL/cell Within normal range, RBCs
are not small nor large, no
signs of anemia or vitamin
deficiencies

Blood Chemistry
SGPT 30 units per liter of serum 7-56 U/L
SGOT 20 units per liter of serum 8-46 U/L
TSH 3.5 mIU/L 0.5-5.0
T4 6.0 μg/dL 5.0 to 12.0 μg/dL
T3 120 ng/dL 100 to 200 ng/dL
Creatinine 0.9 mg/dL 0.6-1.5 mg/dL
BUN 14 mg/dL 8-25 mg/dL
Blood Glucose 110 mg/dL 600-110mg/dL
Alcohol Screening 0 mg/dL <50 mg/dL

Electrolytes
Sodium 137 mEq/L 135-145 mEq/L
Potassium 4 mEq/L 3.5-5.0 mEq/L
Chloride 99 mEq/L 95-105 mEq/L
Calcium 10 mg/dL 8.5-10.5 mg/dL
Urine Drug Screen (-) (-)

Patient’s Results What is the implication of the patient’s results?

MRI No significant findings Normal Brain Study
There are no abnormal focal areas of altered
signal intensity in the cerebral hemispheres,
brainstem or cerebellum. Appearance and
intensity of brain parenchyma is normal.
Ventricular system and cisternal spaces appear
normal. No evidence of intracranial space
occupying lesion or obvious vascular anomaly is
detected. There is no shift of the midline
structures.

References: https://nurseslabs.com/normal-lab-values-nclex-nursing/
Based on Gary’s laboratory results and diagnostics, the psychiatrist diagnosed Gary with Bipolar disorder with
the following orders:
 Antipsychotics
o Quetiapine
 50 mg, bid, for one day
 Followed by 100 mg, Bid, for day 2
 Then 150 mg, BID, on day 3
 Then 200 mg, BID, on day 4
 Mood stabilizers

Page 2 of 8
 o Lithium / Camcolit tab
 Initiate at 1.5 g for five days
 Then at 300-400 mg/day
 Therapy:
o Psychosocial treatment interventions

At present, he has returned home and he’s been placed on a mood stabilizer (after some time on an
antipsychotic), and his psychiatrist is requesting adjunctive psychotherapy for his bipolar disorder. The patient’s
parents are somewhat shocked by the diagnosis, but they acknowledge that Gary had early problems with anxiety during
pre-adolescence, followed by some periods of withdrawal and depression during his adolescence. His parents are eager
to be involved in treatment, if appropriate.

Your Tasks:

1. Conduct a comprehensive Study of the Illness Condition relative to this particular client by:
a. Illustrating the organ involved and label accordingly.
b. Determining the normal function of the organ involved.
c. Explaining the pathophysiology based on the diagnosis.
d. Correlating the client’s signs and symptoms to the disease condition
e. Relates laboratory / diagnostic exams to the illness condition
2. Formulate a Mental Status Exam report based on the client’s presenting signs and symptoms.
3. Formulate Nursing Care Plans for this particular client based on the NANDA approved Nursing Diagnosis.
a. Give at least two (2)
b. PRIORITIZE the problems and cite your reference/s
4. Develop a Drug Study based on your client’s diagnosis with emphasis on the Nursing Considerations in
administering such psychotherapeutic agents.

Page 3 of 8
Output Template

1. Study of the Illness Condition

ASSESSMENT ANATOMY PHYSIOLOGY

This consists of 2 structures: the brain and spinal cord.
Subjective cues: Different sections of the brain regulate and control
 Alcohol Use various regions of our bodies.  The main ones are:
 Depression  Cerebrum (or brain) is divided into two regions,
 Elevated Mood or “hemispheres”, that are connected by an
 Impulsivity information highway, the corpus callosum.  Often
 Irritability the right hemisphere is associated with creativity,
 Mania/Hypomania whereas the left is associated with logic.
 Mood Cycles  Cerebellum (or “little brain”) regulates the
 Risky Behaviors coordination of movement and balance.
 Brain stem controls vital, life support,
Objective cues: involuntary activities (breathing and heart rate).
- Blood alcohol screen test shows no – Each half of the Cerebrum is further divided into four
intoxication. different lobes:
- Urine drug screen test also shows no  Frontal lobe is the higher, control center
drug use. where consciousness lies and is involved in
- CBC were normal, no abnormalities problem solving.
found.  Parietal lobe perceives stimuli such as taste
- Thyroid function is normal. and somatosensory (touch) as well as aiding
- Liver function is normal, liver speech and reading.
functioning properly.  Occipital lobe is devoted to the most
- BUN and Creatinine levels are within information intensive sense of all, vision.
normal, kidney is functioning well.  Temporal lobe controls hearing and speech, as
- Glucose is within range, no signs of well as being involved in the integration of 2 or
diabetes or hypoglycemia. more senses into a meaningful concept.
- Electrolytes are normal.
- No findings on MRI scan, no
abnormalities found.
Reference/s: Reference/s: Reference/s:
http://climatereview.net/ChewTheFat/? http://climatereview.net/ChewTheFat/?p=1015
p=1015
PATHOPHYSIOLOGY ANALYSIS
BIPOLAR DISORDER
Bipolar disorder involves extreme mood swings
from episodes of mania to episodes of
depression. During manic phases, clients are
euphoric, grandiose, energetic, and sleepless.
They have poor judgment and rapid thoughts,
actions, and speech. During depressed phases,
mood, behavior, and thoughts are the same as
in people diagnosed with major depression.
The diagnosis of a manic episode or mania
requires at least 1 week of unusual and
incessantly heightened, grandiose, or agitated
mood in addition to three or more of the
following symptoms (Akiskal, 2017):
- exaggerated self-esteem
- sleeplessness
- pressured speech
- flight of ideas
- reduced ability to filter extraneous stimuli
- distractibility
- increased activities with increased
energy
- multiple, grandiose, high-risk activities
involving poor judgment and severe
consequences, such as spending
sprees, sex with strangers, and
impulsive investments

Gary is a 19-year-old who withdrew from college

after experiencing a manic episode. During his
time in college, he was brought to the attention
of the Campus Police because he pulled
multiple fire alarms in their dorms to ensure that
they were working, a sign of reduced ability to
filter extraneous stimuli. He had a history of
abruptly changing his major from engineering to
philosophy. During this time, he had reduced
 sleep (sleeplessness), spends long hours of
conversation with friends about the nature of
Unable to recognize state or condition; Denying extistence of consdition reality, a sign of pressured speech and flight
Noncompliant with medications and therapy of ideas. He had been convinced about the
Noncompliance importance of his ideas, stating frequently that
to treatment he was more learned and advanced than all his
professors, a sign of exaggerated self
-esteem. He told others that he was on the
Left untreated, bipolar can cause: Problems related to drug and alcohol verge of revolutionizing his new field, which is a
use, Suicide or suicide attempts, Legal or financial problems, Damaged sign of increased activities and he grew
Complications relationships, and Poor work or school performance increasingly irritable and intolerant of any who
disagreed with him. He also increased the
number of high-risk behaviors – drinking and
engaging in sexual relations in a way that was
unlike his previous history, which is an
Extreme highs (Mania) - insomnia, psychosis, jospitalization indication of high-risk activities with poor
Life threatening Extreme lows (Severe Depression) - suicide/attempts, self-harm, death judgement and sever consequences.
complications
LABORATORY/DIAGNOSTIC EXAMS
 CBC and Blood Chem – Blood tests are
conducted to rule out other causes of the
patient’s symptoms. Another is to
examine the prescence of drug or any
substance abuse
Reference/s: Reference/s:
https://www.grepmed.com/images/8224/pathophysiology-mooddisorders-signs-psychiatry-bipolar
Rubric for ALS (PSYCHIATRIC WARD)

4 3 2 1
Follows and
Exceeds Follows some Demonstrates
CATEGORY expectations
Follows
but not all little
instructions
noted in instructions comprehension
instructions
I. STUDY OF ILLNESS CONDITION (total score = 40 points)
1. Assessment
 Differentiates between subjective and objective
cues
 Analyzes laboratory examinations
2. Anatomy
 Illustrates and labels the affected organ
 Cites reference/s and Paraphrases
3. Physiology
 Discusses the normal functions of the organ
involved
 Cites reference/s and Paraphrases
4. Pathophysiology
 Explains the pathophysiology based on the
diagnosis
 Develops the pathologic pathway of the patient’s
current illness
 Synthesizes the life-threatening pathway as a
consequence of the patient’s refusal / non-
compliance with treatment
 Cites reference/s and Paraphrases
5. Analysis
 Correlates signs and symptoms to the illness
condition
 Relates laboratory / diagnostic exams to the illness
condition
II. MENTAL STATUS EXAMINATION (total score = 20 points)
6. Mental Status Examination
 Descriptors are complete with all aspects included
 Shows thorough understanding and
explains ideas clearly with a number of specific
examples included
 Key points and concepts are well-organized and
clearly identified
 Excellent grammar, spelling, and punctuation
 Cites reference/s and paraphrases
III. NURSING CARE PLAN (total score = 36 points)
7. Nursing Care Plan (2)
 Utilizes the Nursing Process
 Assessment
 Diagnosis
 Planning
 Objective of Care
 Interventions
 Rationale
  Implementation
 Evaluation
 Cites reference/s
IV. DRUG STUDY (total score = 12 points)
8. Drug Study
 Comprehensive drug information and cites
references
 Nursing Responsibilities
 Indication / contraindication
(108 + 2) TOTAL POINTS
FINAL RATING

Prepared by: Noted:

MICHEL VINCENT S. CALANTAS, RN, MN DR. MARIA SOCORRO C. DOMINGO

Faculty Clinical Coordinator

FREDIE M. OMAR, MAN, RN

Curriculum Chair

60% Passing Rate

Score Grade Score Grade
106 -110 1.00 61-65 3.25
Approved: 101-105 1.25 56-60 3.5
96-100 1.5 51-55 3.75
91-95 1.75 46-50 4.0
DR. MARY JOSELYN C. BIONG 86-90 2.0 41-45 4.25
Dean 81-85 2.25 36-40 4.5
76-80 2.5 31-35 4.75
71-75 2.75
66-70 3.0 30 below 5.0